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Rosette formation is an unusual finding in malignant lymphomas. We herein report another case of a diffuse large B-cell lymphoma (DLBCL) with ultrastructural evidence of cellular projections, sinusoidal growth pattern, and strong CD30 expression. A literature review of the DLBCL cases showing all these features was also performed.

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Abstract The WHO lymphoma classification has been widely adopted by hematopathologists. However, its practical application in general pathologists is largely unknown. By a hematopathology consultation program in Taiwan, we had reviewed 406 cases. Diagnostic discrepancies were scored based upon whether the divergence would alter disease management according to National Comprehensive Cancer Network guidelines. Major discrepancies accounted for 55% (222/406), minor discrepancies for 5% (20/406), and agreement for 40% (164/406) cases. The more common groups in major discrepancies were non-diagnostic/ambiguous referral reports (116/222, 52%), tumor type revisions (52/222, 23%), and changes from malignant to benign lesions (32/222, 14%). In a total of 259 lymphoma cases, the concordance rates were 41% (77/187) and 33% (24/72) for B-cell and T/NK-cell lymphomas, respectively. It appears that the WHO approach has made the lymphoma classification really poorly reproducible at least in countries where an extensive use of ancillary technique is not employed by general pathologists.

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The appropriate management of hematology patients depends first on correct diagnoses. Expert review is important in reaching accurate diagnoses. To improve diagnostic accuracy, the Taiwan Society of Pathology and the Taiwan Division of the International Academy of Pathology has been conducting an expert consultation program for general pathologists since 2001. As per this program, we have received a total of 395 cases (406 samples) for review. We found that meaningful diagnostic discrepancies occurred frequently in hematopathology reviews. Ambiguous or nondiagnostic original reports were the major causative factor for the major discrepancy cases, which demonstrates that diagnostic uncertainty is a big problem for referring pathologists. However, the World Health Organization lymphoma classification may be poorly reproducible in countries where extensive use of an ancillary technique is not used by general pathologists. This review is intended to report the misdiagnoses most commonly seen in the hematopathology practice in Taiwan. Awareness of the easily misinterpreted entities helps to achieve the right diagnosis and improve patient care.

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